Gynecological cancers present a tremendous disease burden worldwide. Endometrial cancer, the most common gynecological malignancy, is predominantly a disease of deranged glandular function. The mechanisms by which known environmental risk factors influence the mutational profile of endometrial cancer are poorly understood. Non-HPV vulvar cancer, on the other hand, is a very rare gynecological malignancy of vulvar squamous cells with little known about its pathogenesis. Surgical resection of vulvar cancer is associated with high post-surgical morbidity. Pivotal to improving treatment and outcomes for patients with gynecological cancers is an understanding of the molecular drivers unique to each tumor type. To inform our understanding of endometrial gland regulation, I began my investigations with an assessment of normal endometrial adenogenesis in vivo and present the first evidence implicating the necessity of Sox17 in endometrial gland development. My data suggest Sox17 mediates adenogenesis via a non-cell autonomous mechanism from within the stromal compartment of the endometrium. I then interrogated the contribution of SOX17 to dysregulated glandular function in Type I endometrial adenocarcinoma in vitro. My findings reveal an oncogenic role of SOX17 in the Ishikawa Type 1 endometrial cancer cell line, with homozygous loss of SOX17 impairing cellular proliferation, blunting the cancer phenotype of these cells. The majority of cancers, including gynecological cancers, develop from the accumulation of genetic mutations that occur sporadically in cells over time. The complexity and heterogeneity of solid tumors, however, renders the identification of mutations responsible for driving tumorigenesis difficult. The Sleeping Beauty (SB) insertional mutagenesis system can be used to streamline sporadic tumor formation and driver mutation identification. I present results from an initial attempt to develop an SB model of endometrial cancer and discuss ways in which the SB system can be harnessed to evaluate tumorigenesis in a variety of tissue types and microenvironmental contexts. Finally, I present an SB model of metastatic vulvar cancer. Primary tumors from this model resulted in the identification of 76 novel candidate drivers of vulvar cancer, with the ubiquitin-specific peptidase, Usp9x, the most commonly disrupted gene in our screen. I show data suggesting that differential expression of Usp9x isoforms may underlie Usp9x-mediated tumorigenesis and preliminary data demonstrating the relevance of USP9X to human vulvar cancer. Taken as a whole, these data contribute to our scientific understanding of gynecological tissue homeostasis and cancers, lay the foundation for the development of an SB model of endometrial cancer, and describe the first reported model system for studying HPV-naive vulvar cancer in vivo.

Made available in DSpace on 2016-08-10T10:38:52Z (GMT). No. of bitstreams: 1 Tatiane Ribeiro da Fonseca.pdf: 3044117 bytes, checksum: d604b5b291d33d0e053ad75336e7a264 (MD5) Previous issue date: 2014-06-26 / This study evaluated the sociodemographic and clinicopathological aspects of patients with cancer of the vulva and the vagina diagnosed in Araújo Jorge Hospital, Goiânia - GO as well as the prevalence of HPV and HPV16 and 18 genotypes in these tumors. The sample consisted of paraffin embedded samples from 57 patients with primary invasive vulvar cancer and 20 patients with primary invasive cancer of the vagina. The HPV detection was made by polymerase chain reaction (PCR) with SPF (short PCR fragment) 1-2 primers and the HPV 16 and 18 genotyping was performed with primers designed to detect these two genotypes. The results were analyzed by Fisher s exact test. The prevalence of HPV in vulvar cancer samples was 89%. The HPV16 genotype was detected in 42% of positive cases and HPV18 in 24%. The HPV prevalence in vaginal cancer samples was 90%. Among these, 56% were infections by HPV16 and HPV18 by 18%. Over 70% of patients with vulvar and vaginal cancer and positive for HPV detection were over 50 years. Statistical analyzes of the data showed significance of smoking for cancer of the vulva (p = 0.0110). A relationship between lymph node metastasis and cancer of the vulva was also observed (p = 0.0304). A better prognosis for patients with vaginal cancer HPV positive was found (p = 0.0158). A relationship between the degree of tumor differentiation and the presence of HPV in patients with cancer of the vulva was suggested (p = 0.0541). Based on the results presented, it is estimated that the HPV vaccine could have prevented 58% of cases of vulvar cancer and 65% of cases of vaginal cancer of the sample investigated. / O presente estudo avaliou os aspectos sociodemográficos e clinicopatológicos de pacientes com câncer de vulva e vagina diagnosticadas no Hospital Araújo Jorge, Goiânia-GO, bem como a prevalência do HPV e dos genótipos do HPV16 e 18 nesses tumores. A casuística consistiu de amostras parafinizadas de 57 pacientes com câncer invasor primário de vulva e 20 pacientes com câncer invasor primário de vagina. A detecção do HPV foi feita por meio de reação em cadeia da polimerase (PCR) com oligonucleotídeos iniciadores SPF (do inglês short PCR fragment) 1-2 e a genotipagem do HPV16 e 18 foi realizada com oligonucleotídeos iniciadores projetados para a detecção desses dois genótipos. Os resultados foram analisados por Teste Exato de Fisher. A prevalência do HPV nas amostras de câncer de vulva foi de 89%. O genótipo HPV16 foi detectado em 42% dos casos positivos e o HPV18 em 24%. A prevalência do HPV nas amostras de câncer de vagina foi de 90%. Dentre estas, 56% eram infecções pelo HPV16 e 18% pelo HPV18. Mais de 70% das pacientes com câncer de vulva e de vagina positivas para a detecção do HPV tinham mais de 50 anos. As análises estatísticas dos dados demonstraram significância do tabagismo para o câncer de vulva (p=0,0110). Uma relação entre metástase linfonodal e câncer de vulva também foi observada (p=0,0304). Um melhor prognóstico para pacientes com câncer de vagina HPV positivas foi constatado (p= 0,0158). Uma relação entre o grau de diferenciação tumoral e a presença do HPV em pacientes com câncer de vulva foi sugerida (p= 0,0541). Com base nos resultados apresentados, estima-se que a vacina contra o HPV poderia ter prevenido 58% dos casos de câncer de vulva e 65% dos casos de câncer de vagina da casuística investigada.

Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T15:10:17Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-09-29T15:10:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) / Made available in DSpace on 2017-09-29T15:10:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação Livia Gusmao.pdf: 1628245 bytes, checksum: 42849e5f87bd042f59660a228ded7164 (MD5) Previous issue date: 2013 / Hospital Icaraí / O líquen escleroso vulvar está envolvido em uma das vias da carcinogênse da vulva ligada à neoplasia intraepitelial vulvar diferenciada. A metilação da região promotora do DNA é a principal alteração epigenética pela qual um gene é inativado em seres humanos. A metilação do gene P16INK4a, que é um supressor de tumor e atua como inibidor da cinase dependente da ciclina, tem sido descrita como um evento precoce na carcinogênese vulvar. A metilação do gene TIMP-2, que atua como regulador de metaloproteinases, tem sido descrito como marcador de matriz extracelular. Esta pesquisa tem como objetivo estudar a presença da metilação dos genes P16INK4a e TIMP-2 no líquen escleroso vulvar e avaliar a associação das variáveis idade, doença de tireóide, tabagismo, uso de hormônio e prurido vulvar com a metilação dos referidos genes. Trata-se de um estudo transversal, onde foram analisadas 32 amostras obtidas por biópsia de pacientes com líquen escleroso vulvar. As amostras foram submetidas à extração do DNA por meio da técnica do fenol:clorofórmio e à avaliação da metilação dos genes P16INK4a e TIMP-2 pela modificação química do DNA pelo método do bissulfito. O DNA modificado foi submetido à PCR e a visualização do produto pelo gel de poliacrilamida. O estudo da associação de cada uma das variáveis com a metilação de ambos genes não mostrou significado estatístico. Notou-se que 39% (11/28) das amostras exibiram metilação somente para o gene TIMP-2, e nenhuma para o gene P16INK4a isoladamente, enquanto 32% (9/28) apresentaram metilação em ambos genes de forma simultânea. A análise da associação da metilação entre ambos genes mostrou significado estatístico (p=0,0292). Esses resultados sugerem que a associação da metilação entre os genes P16INK4a e TIMP-2 possa promover instabilidade genômica, podendo funcionar como marcador na evolução da doença. Estudos futuros sobre alterações moleculares da matriz extracelular, que por precederem as alterações morfológicas, talvez possam funcionar como sinalizador, individualizando as pacientes com maior risco de evolução do líquen escleroso vulvar para a NIV diferenciada e/ou câncer de vulva / The vulvar lichen sclerosus is involved in one of the pathways of vulvar carcinogenesis linked to differentiated vulvar intraepithelial neoplasia. The methylation of the promoter region of the DNA is the main epigenetic modification in humans in which a gene is inactivated. Methylation of P16INK4a gene, which is a tumor suppressor and acts as an inhibitor of cyclin-dependent kinase, has been described as an early event in carcinogenesis vulva. Methylation of TIMP-2 gene, which acts as a regulator of metalloproteinases, has been described as a marker of extracellular matrix. This research aims to study the presence of methylation of the P16INK4a gene and TIMP-2 in vulvar lichen sclerosus and evaluate the association of age, thyroid disease, smoking, hormone use and vulvar itching with methylation of these genes. It is a cross-sectional study, which analyzed 32 samples obtained by biopsy from patients with vulvar lichen sclerosus. The samples were subjected to DNA extraction by using the technique of phenol: chloroform and evaluation of methylation of the p16INK4a gene and TIMP-2 by chemical modification of DNA by the method of bisulfite. The modified DNA was subjected to PCR and visualization of the product by polyacrylamide gel electrophoresis. The association of each variable in the methylation of both genes showed no statistical significance. It was noted that 39% (11/28) samples showed methylation only to TIMP-2 gene, and none only for the P16INK4a gene, while 32% (9/28) exhibited methylation on both genes simultaneously. The analysis of the association between methylation of both genes showed statistical significance (p = 0.0292). These results suggest that the association between methylation of the P16INK4a gene and TIMP-2 can promote genomic instability, which can act as a marker in the evolution of the disease. Future studies on the molecular alterations of the extracellular matrix, which precede morphological changes, maybe they can function as a signal, separating the patients with higher risk of evolution of vulvar lichen sclerosus to differentiated VIN and / or cancer of the vulva

The aim of this study was a prospective detection of postoperative lymphedema of the lower limbs in patients after the surgery for cervical and vulvar cancer using different methods of examination and their comparison and monitoring of postoperative complications and quality of life. Totally 78 women were followed after the surgery for cervical cancer and 36 for carcinoma of the vulva. Due to the radicality of the surgery the patients were divided into the conservative and radical groups. Lower limbs lymphedema were evaluated preoperatively and 3, 6 and 12 months after the surgery by the measurement of the lower limbs circumference, multifrequency bioelectrical impedance analysis (MFBIA) and subjective feeling. Quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires was evaluated before and 6 and 12 month after the surgery. 12 months after the cervical cancer surgery 35.9 % of patients reported subjective lymphedema, 37.18 % lymphedema were objectively diagnosed by the measurement of lower limb circuits and in 52.56 % of cases the increase of amount of extracellular fluid was detected by the MFBIA Ri/R0 method. The prevalence of lymphedema after the surgery for vulvar cancer reached 19.44% by the subjective assessment, 38.89 % by the measurement of...

The aim of this study was a prospective detection of postoperative lymphedema of the lower limbs in patients after the surgery for cervical and vulvar cancer using different methods of examination and their comparison and monitoring of postoperative complications and quality of life. Totally 78 women were followed after the surgery for cervical cancer and 36 for carcinoma of the vulva. Due to the radicality of the surgery the patients were divided into the conservative and radical groups. Lower limbs lymphedema were evaluated preoperatively and 3, 6 and 12 months after the surgery by the measurement of the lower limbs circumference, multifrequency bioelectrical impedance analysis (MFBIA) and subjective feeling. Quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires was evaluated before and 6 and 12 month after the surgery. 12 months after the cervical cancer surgery 35.9 % of patients reported subjective lymphedema, 37.18 % lymphedema were objectively diagnosed by the measurement of lower limb circuits and in 52.56 % of cases the increase of amount of extracellular fluid was detected by the MFBIA Ri/R0 method. The prevalence of lymphedema after the surgery for vulvar cancer reached 19.44% by the subjective assessment, 38.89 % by the measurement of...